1
|
Zhou L, Yang H, Zhang Y, Wang Y, Zhou X, Liu T, Yang Q, Wang Y. Predictive value of lung function measures for cardiovascular risk: a large prospective cohort study. Thorax 2024; 79:250-258. [PMID: 38050152 DOI: 10.1136/thorax-2023-220703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Although lung function measures are associated with cardiovascular disease (CVD), the added predictive values of these measures remain unclear. METHODS From the UK Biobank, 308 415 participants free of CVD with spirometry parameters were included. The CVD outcomes included were defined by QRISK3, the American College of Cardiology/American Heart Association (ACC/AHA) and the European Systematic Coronary Risk Evaluation (SCORE) prediction models, respectively. Cox proportional hazard models were used to estimate the associations of lung function measures with CVD outcomes. The predictive capability was determined by the decision curve analyses. RESULTS Over a median follow-up of 12.5 years, 21 885 QRISK3 events, 12 843 ACC/AHA events and 2987 SCORE events were recorded. The associations of spirometry parameters with CVD outcomes were L-shaped. Restrictive and obstructive impairments were associated with adjusted HRs of 1.84 (95% CI: 1.65 to 2.06) and 1.72 (95% CI: 1.55 to 1.90) for SCORE CVD, respectively, compared with normal spirometry. Similar associations were seen for QRISK3 CVD (restrictive vs normal, adjusted HR: 1.30, 95% CI: 1.25 to 1.36; obstructive vs normal, adjusted HR: 1.20, 95% CI: 1.15 to 1.25) and ACC/AHA CVD (restrictive vs normal, adjusted HR: 1.39, 95% CI: 1.31 to 1.47; obstructive vs normal, adjusted HR: 1.26, 95% CI: 1.19 to 1.33). Using models that integrated non-linear forced expiratory volume in 1 s led to additional 10-year net benefits per 100 000 persons of 25, 43 and 5 for QRISK3 CVD at the threshold of 10%, ACC/AHA CVD at 7.5% and SCORE CVD at 5.0%, respectively. CONCLUSION Clinicians could consider spirometry indicators in CVD risk assessment. Cost-effectiveness studies and clinical trials are needed to put new CVD risk assessment into practice.
Collapse
Affiliation(s)
- Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hongxi Yang
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yuan Zhang
- Raymond G. Perelman Centre for Cellular and Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yuan Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xin Zhou
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
- School of Integrative Medicine, Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| |
Collapse
|
2
|
Drakopanagiotakis F, Bonelis K, Steiropoulos P, Tsiptsios D, Sousanidou A, Christidi F, Gkantzios A, Serdari A, Voutidou S, Takou CM, Kokkotis C, Aggelousis N, Vadikolias K. Pulmonary Function Tests Post-Stroke. Correlation between Lung Function, Severity of Stroke, and Improvement after Respiratory Muscle Training. Neurol Int 2024; 16:139-161. [PMID: 38251057 PMCID: PMC10801624 DOI: 10.3390/neurolint16010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Stroke is a significant cause of mortality and chronic morbidity caused by cardiovascular disease. Respiratory muscles can be affected in stroke survivors, leading to stroke complications, such as respiratory infections. Respiratory function can be assessed using pulmonary function tests (PFTs). Data regarding PFTs in stroke survivors are limited. We reviewed the correlation between PFTs and stroke severity or degree of disability. Furthermore, we reviewed the PFT change in stroke patients undergoing a respiratory muscle training program. We searched PubMed until September 2023 using inclusion and exclusion criteria in order to identify studies reporting PFTs post-stroke and their change after a respiratory muscle training program. Outcomes included lung function parameters (FEV1, FVC, PEF, MIP and MEP) were measured in acute or chronic stroke survivors. We identified 22 studies of stroke patients, who had undergone PFTs and 24 randomised controlled trials in stroke patients having PFTs after respiratory muscle training. The number of patients included was limited and studies were characterised by great heterogeneity regarding the studied population and the applied intervention. In general, PFTs were significantly reduced compared to healthy controls and predicted normal values and associated with stroke severity. Furthermore, we found that respiratory muscle training was associated with significant improvement in various PFT parameters and functional stroke parameters. PFTs are associated with stroke severity and are improved after respiratory muscle training.
Collapse
Affiliation(s)
- Fotios Drakopanagiotakis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Konstantinos Bonelis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Dimitrios Tsiptsios
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Anastasia Sousanidou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Foteini Christidi
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Aimilios Gkantzios
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Styliani Voutidou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Chrysoula-Maria Takou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (N.A.)
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (N.A.)
| | - Konstantinos Vadikolias
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| |
Collapse
|
3
|
Im Y, Park HY, Lee JY, Kim H, Yoo H, Kang M, Cho SJ, Hwang JH, Park YB, Cho J, Kang D, Shin SH. Impact of preserved ratio impaired spirometry on coronary artery calcium score progression: a longitudinal cohort study. ERJ Open Res 2024; 10:00819-2023. [PMID: 38259813 PMCID: PMC10801717 DOI: 10.1183/23120541.00819-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
Background Preserved ratio impaired spirometry (PRISm) is associated with increased cardiovascular disease (CVD) risk and mortality. However, a causal relationship between PRISm and CVD remains unclear. We investigated the progression of coronary artery calcium (CAC) scores based on the presence of PRISm and reduced forced vital capacity (FVC). Methods This retrospective cohort study included 11 420 participants aged ≥40 years with forced expiratory volume in 1 s (FEV1)/FVC ≥0.7 who underwent at least two health screening examinations with coronary computed tomography scan between 2003 and 2020, and were without a history of CVD or interstitial lung disease. Participants with PRISm, defined as FEV1/FVC ≥0.7 and FEV1 <80% predicted, were further divided by low FVC (FVC <80% predicted). We estimated the 5-year progression rates of CAC by comparing participants with and without PRISm at baseline using mixed linear models. Results Of the 11 420 participants, 8536 (75%), 811 (7%) and 2073 (18%) had normal spirometry, PRISm with normal FVC and PRISm with low FVC, respectively. During the mean (range) follow-up of 6.0 (0.5-17.2) years, the multivariable adjusted ratio of 5-year CAC progression rates comparing participants with PRISm to those with normal spirometry was 1.08 (95% CI 1.04-1.13). This rate was higher in participants with PRISm with low FVC (1.21 (95% CI 1.12-1.30)) than in those with normal FVC. Conclusion In this longitudinal cohort study of subjects without a history of CVD, PRISm was significantly associated with CAC progression, which was more evident in the group with PRISm and low FVC.
Collapse
Affiliation(s)
- Yunjoo Im
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- These authors contributed equally to this work as first authors
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- These authors contributed equally to this work as first authors
| | - Jin-Young Lee
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- These authors contributed equally to this work as first authors
| | - Hyunsoo Kim
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mira Kang
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo Jin Cho
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung Hye Hwang
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Bum Park
- Department of Pulmonary and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
- These authors contributed equally to this work as senior authors
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- These authors contributed equally to this work as senior authors
| |
Collapse
|
4
|
Amaral AFS, Potts J, Knox-Brown B, Bagkeris E, Harrabi I, Cherkaski HH, Agarwal D, Juvekar S, Anand MP, Gislason T, Nafees AA, Mortimer K, Janson C, Loh LC, Paraguas SN, Denguezli M, Al Ghobain M, Mannino D, Njoroge MW, Devereux G, Seemungal T, Barbara C, Kocabaş A, Ahmed R, Aquart-Stewart A, Studnicka M, Welte T, Tan WC, van Zyl-Smit RN, Koul P, Garcia-Larsen V, Minelli C, Buist AS, Burney P. Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study. Int J Epidemiol 2023; 52:e364-e373. [PMID: 37862437 PMCID: PMC10749748 DOI: 10.1093/ije/dyad146] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Affiliation(s)
- Andre F S Amaral
- Ntational Heart and Lung Instiute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - James Potts
- Ntational Heart and Lung Instiute, Imperial College London, London, UK
| | - Ben Knox-Brown
- Ntational Heart and Lung Instiute, Imperial College London, London, UK
| | | | - Imed Harrabi
- Ibn El Jazzar Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Hamid Hacene Cherkaski
- Department of Pneumology, Faculty of Medicine Annaba, University Badji Mokhtar of Annaba, Annaba, Algeria
| | - Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | | | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Sleep, Landspitali—National University Hospital of Iceland, Reykjavík, Iceland
| | - Asaad Ahmed Nafees
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Kevin Mortimer
- University of Cambridge, Cambridge, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Li Cher Loh
- Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Penang, Malaysia
| | | | - Meriam Denguezli
- Laboratoire de Recherche en Physiologie de l’Exercice et Physiopathologie, de l’Intégré au Moleculaire (LR19ES09), Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisia
| | - Mohammed Al Ghobain
- King Saud bin Abdulaziz, University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - David Mannino
- University of Kentucky, Lexington, KY, USA
- COPD Foundation, Miami, FL, USA
| | - Martin W Njoroge
- Centre for Reviews and Dissemination, University of York, York, UK
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Graham Devereux
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Terence Seemungal
- University of The West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago
| | - Cristina Barbara
- Institute of Environmental Health, Lisbon Medical School, University of Lisbon, Lisbon, Portugal
| | - Ali Kocabaş
- Department of Chest Diseases, Çukuova University, School of Medicine, Adana, Turkey
| | - Rana Ahmed
- Epidemiological Laboratory, Khartoum, Sudan
| | - Althea Aquart-Stewart
- Department of Medicine, University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School and German Centre of Lung Research, Hannover, Germany
| | - Wan C Tan
- University of British Columbia, Centre for Heart Lung Innovation, St Paul’s Hospital, Vancouver, BC, Canada
| | - Richard N van Zyl-Smit
- Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Groote Schuur Hospital, Cape Town, South Africa
| | - Parvaiz Koul
- Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Vanessa Garcia-Larsen
- Department of International Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cosetta Minelli
- Ntational Heart and Lung Instiute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - A Sonia Buist
- Oregon Health and Science University, Portland, OR, USA
| | - Peter Burney
- Ntational Heart and Lung Instiute, Imperial College London, London, UK
| |
Collapse
|
5
|
Murrieta-Álvarez I, A Fernández-Gutiérrez J, A Pérez C, León-Peña AA, Reyes-Cisneros ÓA, Benítez-Salazar JM, Sánchez-Bonilla D, Olivares-Gazca JC, Fernández-Lara D, Pérez-Padilla R, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. Impaired lung function in multiple sclerosis: a single-center observational study in 371 persons. Neurol Sci 2023; 44:4429-4439. [PMID: 37410269 DOI: 10.1007/s10072-023-06914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Abnormal lung function in people with multiple sclerosis (PwMS) could be considered as the result of muscle weakness or MS-specific structural central nervous system (CNS) abnormalities as a precipitant factor for the worsening of motor impairment or cognitive symptoms. METHODS This is a cross-sectional observational study in PwMS. Forced spirometry was conducted, and normative metrics of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the relation FEV1/FVC were calculated. Qualitative and quantitative brain magnetic resonance imaging (MRI) examinations were carried out. RESULTS A total of 371 PwMS were included in the study. Of those, 196 (53%) had RRMS, 92 (25%) SPMS, and 83 (22%) PPMS. Low FVC and FEV1 was present in 16 (8%), 16 (19%), and 23 (25%) of the patients in the RRMS, PPMS, and SPMS, respectively. PwMS with T2-FLAIR lesions involving the corpus callosum (CC) had a significantly higher frequency of abnormally low FVC and FEV1 (OR 3.62; 95% CI 1.33-9.83; p = 0.012) than patients without lesions in that region. This association remained significant in the RRMS group (OR 10.1; 95% CI 1.3-67.8; p 0.031) when the model excluded PPMS and SPMS. According to our study, for every increase of 1 z score of FVC, we observed an increase of 0.25 cm3 of hippocampal volume (β 0.25; 95% CI 0.03-0.47; p 0.023) and 0.43 cm3 of left hippocampus volume (β 0.43; 95% CI 0.16-0.71; p 0.002). CONCLUSIONS We observed an incremental prevalence of abnormally low pulmonary function tests that parallels a sequence from more early relapsing courses to long-standing progressive courses (RRMS to PPMS or SPMS).
Collapse
Affiliation(s)
- Iván Murrieta-Álvarez
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Baylor College of Medicine, Houston, TX, USA
| | - José A Fernández-Gutiérrez
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | | | | | - Óscar A Reyes-Cisneros
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Anáhuac Puebla, Tlaxcalancingo, México
| | - José M Benítez-Salazar
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Houston Methodist Hospital, Houston, TX, USA
| | - Daniela Sánchez-Bonilla
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | | | | | | | - Guillermo J Ruiz-Delgado
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Laboratorios Ruiz SYNLAB, Puebla, México
| | - Guillermo J Ruiz-Argüelles
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México.
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México.
- Laboratorios Ruiz SYNLAB, Puebla, México.
| |
Collapse
|
6
|
Li G, Jankowich MD, Lu Y, Wu L, Shao L, Ke C. Preserved Ratio Impaired Spirometry, Metabolomics, and the Risk of Type 2 Diabetes. J Clin Endocrinol Metab 2023; 108:e769-e778. [PMID: 36897159 DOI: 10.1210/clinem/dgad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023]
Abstract
CONTEXT Whether baseline preserved ratio impaired spirometry (PRISm) is associated with the risk of developing type 2 diabetes (T2D) and if this association could be mediated by circulating metabolites remains to be elucidated. OBJECTIVE To measure the prospective association of PRISm with T2D and potential metabolic mediators thereof. METHODS This study used data from the UK Biobank and included 72 683 individuals without diabetes at baseline. PRISm was defined as the predicted forced expiratory volume in 1 second (FEV1) <80% and the FEV1/forced vital capacity ratio ≥0.70. Cox proportional hazards modeling was performed to assess the longitudinal relation between baseline PRISm and incident T2D. Mediation analysis was used to explore the mediation effects of circulating metabolites in the path from PRISm to T2D. RESULTS During a median follow-up of 12.06 years, 2513 participants developed T2D. Individuals who had PRISm (N = 8394) were 47% (95% CI, 33%-63%) more likely to develop T2D compared with those who had normal spirometry (N = 64 289). A total of 121 metabolites showed statistically significant mediation effects in the path from PRISm to T2D (false discovery rate <0.05). Glycoprotein acetyls, cholesteryl esters in large high-density lipoprotein (HDL), degree of unsaturation, cholesterol in large HDL, and cholesteryl esters in very large HDL were the top 5 metabolic markers, with mediation proportions (95% CI) being 11.91% (8.76%-16.58%), 11.04% (7.34%-15.55%), 10.36% (7.34%-14.71%), 9.87% (6.78%-14.09%), and 9.51% (6.33%-14.05%), respectively. A total of 11 principal components that explained 95% variance of the metabolic signatures accounted for 25.47% (20.83%-32.19%) of the relation between PRISm and T2D. CONCLUSIONS Our study revealed the association of PRISm with T2D risk and the potential roles of circulating metabolites in mediating this association.
Collapse
Affiliation(s)
- Guochen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, P. R. China
| | - Matthew D Jankowich
- Section of Pulmonary and Critical Care Medicine, Medical Service, Providence VA Medical Center, Providence, RI 02908, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Yanqiang Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, P. R. China
| | - Luying Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, P. R. China
| | - Liping Shao
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, P. R. China
| | - Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, P. R. China
| |
Collapse
|
7
|
Sakhamuri S, Seemungal T. Beyond airflow obstruction: acknowledging the diversity of abnormal spirometry patterns. ERJ Open Res 2023; 9:00193-2023. [PMID: 37404846 PMCID: PMC10316041 DOI: 10.1183/23120541.00193-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/20/2023] [Indexed: 07/06/2023] Open
Abstract
Restrictive spirometry patterns and PRISm may not be the same, potentially leading to missed detection of a considerable number of individuals with abnormal spirometry. It is essential to consider all spirometry indices carefully during interpretation. https://bit.ly/43pXzep.
Collapse
Affiliation(s)
| | - Terence Seemungal
- Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| |
Collapse
|
8
|
Knox-Brown B, Sylvester K, Amaral AF. The association of cardiorespiratory fitness with spirometric small airway obstruction. ERJ Open Res 2023; 9:00275-2023. [PMID: 37650082 PMCID: PMC10463036 DOI: 10.1183/23120541.00275-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/27/2023] [Indexed: 09/01/2023] Open
Abstract
Spirometric small airway obstruction is associated with impaired ventilatory response to exercise independently of FEV1/FVC ratio https://bit.ly/3pre4sk.
Collapse
Affiliation(s)
- Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Karl Sylvester
- Respiratory Physiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Respiratory Physiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andre F.S. Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| |
Collapse
|
9
|
Knox-Brown B, Patel J, Potts J, Ahmed R, Aquart-Stewart A, Barbara C, Buist AS, Cherkaski HH, Denguezli M, Elbiaze M, Erhabor GE, Franssen FME, Al Ghobain M, Gislason T, Janson C, Kocabaş A, Mannino D, Marks G, Mortimer K, Nafees AA, Obaseki D, Paraguas SNM, Loh LC, Rashid A, Salvi S, Seemungal T, Studnicka M, Tan WC, Wouters EFM, Abozid H, Mueller A, Burney P, Amaral AFS. The association of spirometric small airways obstruction with respiratory symptoms, cardiometabolic diseases, and quality of life: results from the Burden of Obstructive Lung Disease (BOLD) study. Respir Res 2023; 24:137. [PMID: 37221593 DOI: 10.1186/s12931-023-02450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/13/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Spirometric small airways obstruction (SAO) is common in the general population. Whether spirometric SAO is associated with respiratory symptoms, cardiometabolic diseases, and quality of life (QoL) is unknown. METHODS Using data from the Burden of Obstructive Lung Disease study (N = 21,594), we defined spirometric SAO as the mean forced expiratory flow rate between 25 and 75% of the FVC (FEF25-75) less than the lower limit of normal (LLN) or the forced expiratory volume in 3 s to FVC ratio (FEV3/FVC) less than the LLN. We analysed data on respiratory symptoms, cardiometabolic diseases, and QoL collected using standardised questionnaires. We assessed the associations with spirometric SAO using multivariable regression models, and pooled site estimates using random effects meta-analysis. We conducted identical analyses for isolated spirometric SAO (i.e. with FEV1/FVC ≥ LLN). RESULTS Almost a fifth of the participants had spirometric SAO (19% for FEF25-75; 17% for FEV3/FVC). Using FEF25-75, spirometric SAO was associated with dyspnoea (OR = 2.16, 95% CI 1.77-2.70), chronic cough (OR = 2.56, 95% CI 2.08-3.15), chronic phlegm (OR = 2.29, 95% CI 1.77-4.05), wheeze (OR = 2.87, 95% CI 2.50-3.40) and cardiovascular disease (OR = 1.30, 95% CI 1.11-1.52), but not hypertension or diabetes. Spirometric SAO was associated with worse physical and mental QoL. These associations were similar for FEV3/FVC. Isolated spirometric SAO (10% for FEF25-75; 6% for FEV3/FVC), was also associated with respiratory symptoms and cardiovascular disease. CONCLUSION Spirometric SAO is associated with respiratory symptoms, cardiovascular disease, and QoL. Consideration should be given to the measurement of FEF25-75 and FEV3/FVC, in addition to traditional spirometry parameters.
Collapse
Affiliation(s)
- Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK.
| | - Jaymini Patel
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - James Potts
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Rana Ahmed
- The Epidemiological Laboratory (Epilab), Khartoum, Sudan
| | | | - Cristina Barbara
- Faculdade de Medicina, Instituto de Saúde Ambiental, Universidade de Lisboa, Lisbon, Portugal
- Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - A Sonia Buist
- Oregon Health & Science University, Portland, OR, USA
| | - Hamid Hacene Cherkaski
- Dept of Pneumology, Faculty of Medicine Annaba, University Badji Mokhtar of Annaba, Annaba, Algeria
| | - Meriam Denguezli
- Faculté de Médecine Dentaire de Monastir, Université de Monastir, Avenue Avicenne, Monastir, Tunisia
| | - Mohammed Elbiaze
- Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, University Hospital, Fes, Morocco
| | | | - Frits M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Research and Education, CIRO, Horn, the Netherlands
| | - Mohammed Al Ghobain
- King Abdullah International Medical Research Centre, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Ali Kocabaş
- Department of Chest Diseases, Cukurova University School of Medicine, Adana, Turkey
| | - David Mannino
- University of Kentucky, Lexington, KY, USA
- COPD Foundation, Miami, FL, USA
| | - Guy Marks
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Kevin Mortimer
- University of Cambridge, Cambridge, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Asaad Ahmed Nafees
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Stefanni Nonna M Paraguas
- Philippine College of Chest Physicians, Quezon City, Philippines
- Philippine Heart Centre, Quezon City, Philippines
| | - Li Cher Loh
- RCSI & UCD Malaysia Campus, Penang, Malaysia
| | | | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
- Symbiosis International (Deemed University), Pune, India
| | - Terence Seemungal
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Michael Studnicka
- University Clinic for Pneumology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Hazim Abozid
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | | | - Peter Burney
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Andre F S Amaral
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| |
Collapse
|
10
|
Tang W, Rong Y, Zhang H, Zhan Z, Yuan L, Ning Y, Lin W. The correlation between a Th1/Th2 cytokines imbalance and vitamin D level in patients with early chronic obstructive pulmonary disease (COPD), based on screening results. Front Physiol 2023; 14:1032786. [PMID: 37008007 PMCID: PMC10063780 DOI: 10.3389/fphys.2023.1032786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
Objective: This study explored the correlation between a Th1/Th2 cytokines imbalance and 25-hydroxy-vitamin D (vit D) level in early chronic obstructive pulmonary disease (COPD), provided experimental rationales for the role of vit D in the prevention and control of COPD, and elucidated the potential anti-inflammatory mechanism involved.Methods: This study was based on the results of the “Screening and Early Diagnosis of COPD” public health project conducted through Shenzhen Municipal Qianhai Shekou Free Trade Zone Hospital. Patients with early COPD were selected as study participants. A prospective, randomized, and controlled method was employed for assigning eligible participants into three groups, i.e., a COPD lung function (LF) I, COPD LF II, and a healthy group, respectively (n = 40 each). The serum content of tumor necrosis factor alpha (TNF-α), interferon-gamma (IFN-γ), interleukin 4 (IL-4), and IL-6 were measured by enzyme-linked immunosorbent assay, and the ratio of IFN-γ/IL-4 treated as a marker for Th1/Th2. The serum concentration of 25-hydroxyl-vit D (25 [OH]D) was quantified by a chemiluminescence assay. Statistical processing was performed, and the correlations between changes in the above parameters with vit D level and LF parameters were examined.Results: There were differences in FEV1pred%, FEV1/FVC, IFN-γ, IL-4, IL-6 and IFN-γ/IL-4 between the healthy group, the COPD LF I group and the COPD LF II group (p < 0.05). In early COPD, Th1/Th2 cytokines was positively correlated with forced expiratory volume/expected value (FEV1pred%) (r = 0.485, p < 0.001) and forced expiratory volume/forced vital capacity (FEV1/FVC) (r = 0.273, p = 0.018); Th1/Th2 cytokines levels positively correlated with vit D level (r = 0.27, p = 0.02), and 25(OH)D level positively correlated with FEV1pred% (r = 0.695, p < 0.001).Conclusion: Vitamin D deficiency was ubiquitous in patients with early COPD. It was positively correlated with the FEV1pred% and FEV1/FVC LF parameters. Accordingly, this study provides experimental rationales for the role of vit D in the prevention and control of COPD and the potential anti-inflammatory mechanisms involved.
Collapse
|
11
|
Burney P, Knox-Brown B, Amaral AFS. Small lung syndrome: the need to reclassify chronic lung disease. THE LANCET RESPIRATORY MEDICINE 2023; 11:405-406. [PMID: 37003282 DOI: 10.1016/s2213-2600(23)00091-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Peter Burney
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK.
| | - Ben Knox-Brown
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK
| | - André F S Amaral
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK; National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| |
Collapse
|
12
|
Zhang Y, Cheng C, Wei F, Wu Z, Cui H, Liu L, Lu F, Peng J, Yang J. Reduced peak expiratory flow predicts increased risk of cardiovascular disease: A 10-year prospective cohort study in Eastern China. Respir Med Res 2023; 83:100988. [PMID: 36634554 DOI: 10.1016/j.resmer.2022.100988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The correlation between impaired lung function and cardiovascular diseases (CVD) has attracted more and more attention. We aimed to assess the longitudinal association between decreased peak expiratory flow (PEF) and cardiovascular risk among Eastern Chinese general population. METHODS In total, 6295 participants aged>30 years and free of CVD at baseline were followed for up to 10 years in Eastern China. The adjusted hazard ratios (HRs) for CVD and mortality associated with decreased PEF were analyzed. RESULTS Among all participants, 421 CVD incident events were reported during 10-year follow-up, and a total of 272 participants died during the follow-up period, 94 of them from CVD. The HRs in the lowest group of PEF (PEF ≤218.33 L/min) were 1.31 (95% confidence interval [CI]:1.01 to 1.68) for high CVD incidence (172 vs 116), 2.43 (95% CI:1.72 to 3.42) for all-cause mortality (156 vs 48), and 3.94 (95% CI:1.96 to 7.92) for CVD mortality (59 vs 10) when compared with the highest group (PEF ≥321.68 L/min). CONCLUSION The decreased PEF was associated with increased CVD incidence, CVD and all-cause mortality in Eastern Chinese general population.
Collapse
Affiliation(s)
- Yerui Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Cheng Cheng
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China; Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110004, China
| | - Fang Wei
- Jinan Central hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhenguo Wu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Huiliang Cui
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Li Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Shandong Academy of Medical Sciences, Jinan, China
| | - Jie Peng
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Key Laboratory of Cardiovascular Proteomics of Shandong Province, Jinan, China.
| | - Jianmin Yang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
| |
Collapse
|
13
|
Fang NN, Wang ZH, Li SH, Ge YY, Liu X, Sui DX. Pulmonary Function in Metabolic Syndrome: A Meta-Analysis. Metab Syndr Relat Disord 2022; 20:606-617. [PMID: 36125502 DOI: 10.1089/met.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: This study aims to systematically evaluate the association between metabolic syndrome (MS) and pulmonary function through meta-analysis. Methods: Electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, were systematically searched to obtain articles associated with MS and lung function published before December 31, 2021. According to the including and excluding criteria, certain studies were obtained and data were extracted. The Newcastle Ottawa Scale was used to evaluate the quality of the studies. A pooled standardized mean difference (SMD) was calculated by means of random-effects meta-analysis. Different effect models were used according to the heterogeneity. Meta-regression and sensitivity analyses were performed to examine the possible sources of heterogeneity. The Begg's funnel plot and Egger's test were used to evaluate publication bias. Analyses were performed using Stata MP, version14.0 (StataCorp LP, College Station, TX, USA). Results: A total of 15 studies, involving 10,285 cases of MS and 25,416 cases of control, were included in this meta-analysis on the relationship between MS and forced vital capacity (FVC). The pooled SMD for FVC was -0.247 (95% CI = -0.327 to -0.2167, P < 0.001) using random effect model, indicating the decrease of FVC in the patients with MS. In the same studies, the pooled SMD for forced expiratory volume in 1 sec (FEV1) was -0.205 (95% CI = -0.3278 to -0.133, P < 0.001), indicating the decrease of FEV1 also existed in the MS cases. A total of 13 studies, involving 8167 cases of MS and 19,788 cases of control, were included in this meta-analysis on the relationship between MS and FEV1/FVC. The pooled SMD for FEV1/FVC was 0.011 (95% CI = -0.072 to 0.093, P = 0.798) using random effect model, indicating that there was no significant difference between the patients with MS and the control. After introducing the diastolic blood pressure and glycemia into the regression model of the relationship between MS and FVC, the variance of the studies (tau2) decreased from 0.0190 to 0.006694 and 0.007205, which could explain 66.70% and 78.04% of the sources of heterogeneity, and the P values were 0.038 and 0.023. The results suggested that hypertension (diastolic pressure) and hyperglycemia were the factors linked to the heterogeneity among the included studies on both FVC and FEV1. The Begg's funnel plot and Egger's test both showed no evidence of publication bias. Conclusions: Our results show that FVC and FEV1 decrease in MS patients, while FEV1/FVC has no significant difference compared with the control group. It indicates that the patients with MS have restrictive ventilatory functional disturbance. Meta-regression analysis suggests that hypertension (diastolic pressure) and hyperglycemia are the factors linked to the heterogeneity among the included studies on both FVC and FEV1.
Collapse
Affiliation(s)
- Ning-Ning Fang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zhi-Hao Wang
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shao-Hua Li
- Department of Cardiology, Shandong Provincial Hospital of Shandong University, Jinan, Shandong, China
| | - Yu-Yan Ge
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xin Liu
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Dong-Xin Sui
- Department of Respiration, The Second Hospital of Shandong University, Jinan, Shandong, China
| |
Collapse
|